Cornell Health

Why Cornell’s Clinicians Need Cross Training

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As Cornell University administrators consider the recommendations from a mental health review released last October, Cornell Health needs to cross train all of its clinicians to diagnose and treat substance abuse disorders and other mental health disorders as soon as possible.

Cross training is an important consideration in all health services, but it is especially necessary for clinicians who work with college students. For example, a female student sought help from her college’s counseling program because she was feeling anxious and depressed. She met with a counselor for several weeks but experienced no relief. Her counselor decided to seek advice and brought her case to the counseling service’s weekly clinical meeting. After a lengthy discussion, another counselor asked, “Did you ask about her drinking?” No, the counselor had not asked about her drinking because she focused on the presenting problems, anxiety and depression. In the end, the counselor diagnosed the student as having a serious alcohol use disorder and treated her successfully for both addiction and depression.

Another in an occasional series of articles about student mental health. For more information, go to The Sophie Fund’s Student Mental Health Page

Clinical services, whether in the workplace or on a college campus, have a common problem: most clinicians do not have sufficient training to diagnose and treat both substance use disorders and other mental health disorders. This occurs primarily because clinical training programs often do not provide social workers, psychologists, and psychiatrists with sufficient background and skills to diagnose and treat substance abuse disorders, particularly addiction.

At the same time, programs specializing in training counselors about substance use disorders may give short shrift to the diagnosis and treatment of other mental health disorders. Clinical services can rectify this problem by ensuring that all clinicians are cross-trained to the point of competence where they can identify, assess, and intervene on both substance abuse disorders and other mental health issues.

Cross training is especially important for college counseling services because college students drink, sometimes excessively, and use and abuse other drugs such as marijuana, prescription drugs (e.g. Adderall and Ritalin), Ecstasy, and cocaine. Since the 1990s, college health practitioners have utilized two approaches to prevent and treat substance use disorders among students.

The first is a harm reduction model. For example, it seeks to reduce the harm associated with excessive drinking by teaching students to drink responsibly. Within this framework, college health practitioners think of heavy drinking as a symptom of an underlying social problem, a dysfunctional “culture,” and they create programs such as social norming campaigns and BASICS (Brief Alcohol Screening & Intervention for College Students) to teach students moderate drinking norms with the expectation that students will change their behavior and drink moderately or not at all.

The second approach conceives of substance use as a coping mechanism that students use to relieve stress, anxiety, and depression. By treating the stress, anxiety, and depression, clinicians believe that students will be less reliant on alcohol and other drugs to cope and use alcohol and other drugs responsibly. These interventions work well with students who are not addicted and are abusing alcohol or other drugs, but they are inadequate for treating those who are addicted to alcohol and other drugs.

More recently, colleges have begun to recognize that many college students who drink excessively and abuse other drugs cannot control their consumption because they are dependent upon alcohol and other drugs and many college health services have begun to develop recovery programs to treat their addiction. One study, for example, found that 18 percent of college students have an alcohol use disorder: 12 percent met the criteria for a diagnosis for alcohol abuse and six percent met the criteria for a diagnosis of alcohol dependence.

Interview skills are essential for making an accurate diagnosis and ensuring effective treatment. Mental health clinicians and addiction specialists can learn from one another to improve their skills.

Again, the classic example is the depressed client who seeks help from a mental health practitioner for depression. A male student sees a mental health clinician who focuses the interview on his symptoms of depression and reasonably prescribes anti-depressants and talk therapy. However, the clinician misses the fact that the client is implying that his alcohol consumption is minimal but is actually consuming large quantities of a depressant (i.e. alcohol). The therapist does not consider the patient’s self-medication and prescribes antidepressants.

In the opposite scenario, the same male student sees an alcohol and drug counselor to discuss his potential abuse of alcohol. The counselor does a standard intake evaluation and determines that he does meet all the criteria for alcohol addiction but, because of the nature of the questions asked, the counselor misses the fact that this person has had all the symptoms of depression since before he ever took his first drink. In both scenarios, the most effective treatment requires the clinician to diagnose both the addiction and depression and treat them in an integrated manner. Treating only the depression will perpetuate the addiction, the pain, and dysfunction. Only treating the addiction will perpetuate the depression and likely lead to ongoing suffering and relapse.

Cross training ensures that health services deliver the most competent care in the most cost effective manner. The only thing worse than not getting the help one needs is thinking you are getting help when you are not. Clinicians owe it to their patients to be able to assess issues across the mental health spectrum. As Cornell Health responds to the mental health review, it can ensure that students receive the most effective care by guaranteeing that all of its clinicians have sufficient training to diagnose and treat both substance use disorders and other mental health disorders.

—By William J. Sonnenstuhl and G.P. Zurenda

William J. Sonnenstuhl is an emeritus professor in the School of Industrial and Labor Relations (ILR) at Cornell University. His primary research examines alcohol and drug problems in the workplace and on college campuses. He is the faculty advisor for Sober@Cornell, President of Cornell Collegiate Recovery, Inc., board member of Cayuga’s Watchers, and member of the Fraternity, Sorority, and Alumni Council.

G.P. Zurenda is a social worker and addiction specialist. He holds an MBA from the SC Johnson College of Business.

Report Card: D- for Cornell’s Mental Health Leave of Absence Policy

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In a scathing critique of student mental health at Ivy League schools, a new report gives Cornell University a grade of D- for its mental health leave of absence policy. No Ivy scored higher than a D, and Yale and Dartmouth were assigned F grades.

“The leave of absence policies do not reflect institutional commitment to supporting students with mental health disabilities,” the report said. “When it comes to inclusion of students with mental health disabilities, the Ivy League schools do not provide the leadership that the landscape of higher education desperately needs…The findings demonstrate that the Ivy League schools, the most elite institutions in our nation, are failing to lead the sector of higher education in supporting students with mental health disabilities.”

The Ruderman Family Foundation, a Boston-based organization advocating for and advancing the inclusion of people with disabilities in our society, issued the report in December. The report, “The Ruderman White Paper on Mental Health in the Ivy League,” was authored by Miriam Heyman, a foundation program officer responsible for the development and oversight of disability inclusion programs.

While generally critical of how universities are meeting student mental health challenges, the report focuses on the aspect of leave of absence policies. Noting that a health leave is a potentially useful mechanism enabling a student to focus on well being and recovery, “schools may also use the leave of absence as a tool for discrimination, pushing students out of school who are entitled by law to receive accommodations and supports which would enable them to stay.”

The report claims that college campuses are facing a unique crisis, arguing that the prevalence rates of mental illness among college students are far larger than prevalence rates for age-matched non-college individuals.

The Ruderman report says:

“Meanwhile, college resources provide woefully inadequate support to students. … The scope of the problem, combined with the lack of resources available to address the problem, is exerting a horrible toll. Suicide is among the most tragic consequences of untreated mental illness and it is the second leading cause of death of college students…”

“Clearly, colleges need to invest in increasing the availability of mental health professionals on campus. One clinician for every one thousand students is not enough, and this ratio represents the availability of clinicians on the campuses with the most resources.”

The report speculates that college administrators are wary of bad press coverage about campus suicides, and that their fear of a lawsuit if a student takes their own life motivates them to remove students from campus.

In the study, Ruderman cited “problematic” issues in seven of 15 categories related to Cornell’s leave of absence policy. It said there was “room for improvement” in two other issues, and that the university followed “best practice” in six others.

Here are the 15 categories and Cornell’s scores in them:

PUTTING A STUDENT ON LEAVE

1. Does the involuntary leave policy include “threat to self” language (with the premise that the inclusion of this language is facially discriminatory)?

The policy states, “…whether the student’s behavior is disruptive of the university’s learning environment and whether the behavior poses a direct threat to the safety of others…”

Grade: Best Practice

 
2. Do leave policies specify that the student is entitled to reasonable accommodations which would enable them to stay at school?

The policy states, “Consideration will also be given to accommodations that may reasonably be provided that will mitigate the need for the involuntary leave.” There is no mention of individualized assessment.

Grade: Ambiguous / Room for improvement

 
3. Do leave policies include language against generalization, fear, or stereotype?

There is no language against generalization, fear, or stereotype.

Grade: Problematic

 
4. Is there language about community disruption?

The policy states, “When there is an actual or the threat of a community disruption, Cornell University may place a student on an involuntary leave of absence.”

Grade: Problematic

 
5. Does the policy empower students to work with mental health professionals of their choice?

The student must get approval to take a leave and return from leave from Cornell Health (it can’t be an outside treatment provider). Also, a Cornell Health clinician or counselor will provide “…specific treatment recommendations as part of the HLOA agreement. Compliance with the treatment expectations is a primary factor in approving a student’s return to Cornell.”

Grade: Problematic

 
6. Can the student initiate the process at any time?

There are no health leaves of absence after the last day of classes.

Grade: Problematic

 
7. Are policies and procedures transparent?

All decisions regarding return from an HLOA are made by an interdisciplinary committee of Cornell Health clinicians. Student requests to return are denied only when the committee is unanimous in its opinion that a return is not advisable at this time. The return process checklist also provides transparency. Also, the involuntary leave policy states that involuntary leaves are imposed only “in extraordinary circumstances.”

Grade: Best practice

 
THE LEAVE ITSELF

8. Is there a minimum length of time for the leave?

The policy states, “The duration of the leave is to be determined by the vice president for student and campus life based on the facts and circumstances leading up to the imposition of the involuntary leave…For health leave, amount of time will depend on the circumstances.” The mental health provider report requests information, including “Once achieved, has the substantial reduction [in behaviors such as suicidal behaviors, self injury, food purging] been maintained stably for 3 consecutive months?” This may suggest that three months is the minimum duration.

Grade: Ambiguous / Room for improvement

 
9. Does the school specify a maximum duration or maximum number of leaves?

There is no language about maximum number or duration.

Grade: Best Practice

 
10. Does the policy identify a liaison or contact person at the school?

The policy does not identify a liaison or a contact person.

Grade: Problematic

 
11. Are students on leave prohibited from visiting campus?

The policy states, “The student may visit campus only as authorized in writing by the vice president for student and campus life.” The policy states, “Where appropriate, impose a persona non grata order on a student who has been placed on involuntary leave.”

Grade: Problematic

 
12. Are there work or school requirements?

The policy states, “It is expected that the student uses the time away from the University for treatment and recovery.” The policy states, “Until the student complies with the pre-requisites to enrollment mandated by the vice president for student and campus life. An individualized assessment will be made for the student to determine if the pre-requisites have been satisfied.”

Grade: Best practice

 
RETURNING FROM LEAVE

13. What is the deadline to apply for return?

The student must notify Cornell Health in writing of their wish to return by June 1 for a Fall return and November 1 for a Spring return. Submit documentation by July 1 for fall semester return, by December 1 for spring semester return. The score is based on the documentation deadlines.

Grade: Best Practice

 
14. Does the policy mention confidentiality, and facilitate confidentiality by specifying that medical records should be submitted to health services, not school administration?

Voluntary leave policy states – “December 22, 2017: Added note at end of procedures indicating that requests for health-care related leaves should be referred to Cornell Health to initiate the HLOA [Health Leave of Absence] process, and that academic units should not request health information or medical records directly from a student.” There is no explicit mention of confidentiality.

Grade: Ambiguous / Room for improvement

 
15. Does the policy facilitate student participation in university housing?

The policy does not mention housing.

Grade: Problematic

 
The rating system allotted a score of 1 if problematic, 2 if there was room for improvement, and 3 for best practice.

The Ivy League ratings:

Brown University: 29/45 D

Columbia University: 29/45 D

Cornell University: 28/45 D-

Dartmouth: 23/45 F

Harvard University: 28/45 D-

Princeton University: 29/45 D

University of Pennsylvania: 31/35 D+

Yale University: 24/45 F

A report on Cornell student mental health by the JED Campus program published in April included recommendations on health leave of absences:

“Develop/refine a written medical leave of absence policy that is consistent with JED Campus recommendations.”

“Ensure that all leave policies are transparent and easily accessible to the campus community.”

Cornell responded saying:

“Cornell Health continues to work with all of the academic units at Cornell to make the health leave process as straight forward as possible.

“The university’s Voluntary Leave policy was recently revised in December 2017 to address identified issues.”

In 2017, The Sophie Fund, an Ithaca nonprofit organization advocating for youth mental heath, released a proposal aimed at supporting students taking leaves of absence for mental health reasons from Cornell University, Ithaca College, and Tompkins Cortland Community College.

The proposal calls for an Ithaca community-based program featuring a “leave of absence coach,” a community outreach worker providing practical guidance and moral support for students in transition. It also proposes a website hosting useful information about college leave policies, strategies for fruitful time off from school, local housing options, and employment opportunities. To date, no tangible progress has been made in funding or implementing the proposal.

“Leaves of absence entail an often unexpected, abrupt, and painful loss of a structured environment that includes a support network of friends, professors, university staff, roommates and other fellow students, campus organizations, cultural and athletic facilities, and school medical providers,” the proposal says. “Testimonies from students on mental health leaves of absence relate how it can be a confidence-crushing experience that induces shame and guilt.”

Click here to download a copy of the proposal.

In April 2017 and again in August 2018, The Sophie Fund’s founders, Scott MacLeod and Susan Hack, called on Cornell University President Martha E. Pollack to launch an independent external-led review of student mental health. They said the review should include “Cornell’s policies, programs, and practices for students taking HLOA for mental health reasons.”

In a September 18 email to Cornell students reported by the Cornell Daily Sun, Vice President Ryan Lombardi announced plans for “a comprehensive review of student mental health” that will bring together “internal and external partners.”

In a September 18 email to the Sun, Lombardi said: “While for many years the university has engaged in regular assessment of student mental health needs and evaluation of services and programs, the decision to pursue an additional comprehensive review of student mental health reflects the University’s commitment to promoting health and well-being as a foundation for academic and personal success.”

Spike for Sophie

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Cornell University’s Student-Athlete Advisory Committee (SAAC) is holding its annual fundraiser next week featuring a spikeball tournament and a bench press challenge. This year’s theme is mental health and all proceeds will be donated to The Sophie Fund.

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The “Spike for Sophie” fundraiser will take place in the Richard Ramin Multipurpose Room of Bartels Hall on December 5 from 2–4:30 p.m. The spikeball tournament is open to the whole campus, a single-elimination event with a $10 per team entry fee. Pick-up spikeball will be available. Teams, which will compete for 1st, 2nd, and 3rd place prizes, can sign up for the tournament at this link.

The event also includes “Bench Press for Sophie,” where Cornell student-athletes and coaches will raise money from their sponsors—family, friends, and professors—by bench pressing as many reps as they can—55 lbs. for women and 95 lbs. for men. The event will take place in the Friedman weight room.

There will be bench press t-shirts, sports massages ($1/minute up to 10 minutes), free food, and mental health information tables. Public Health Fellow and former Cornell football student-athlete Baba Adejuyigbe will staff the Cornell Health table. It will focus on educating students on the various mental health support services on Cornell’s campus in addition to counseling, with an emphasis on the new resources available to student-athletes. Representatives from The Sophie Fund will also host a table with information about the organization and to answer questions from students.

SAAC is the voice of student-athletes on the Cornell campus, and strives to promote a positive student-athlete experience through providing feedback to conference and national legislation on campus issues, organizing community service events, and acting as a communication line between student-athletes and campus administrators.

The NCAA Division 1 SAAC as a whole has put a focus on mental health awareness in athletics this year, so our SAAC here at Cornell took it upon ourselves to raise awareness and address the mental health issues on our campus. We believe mental health is a big and unaddressed issue in the student-athlete community at Cornell and we are committed to changing this culture.

Student-athletes face all the struggles of a normal student at Cornell, in addition to the time restraints of practices and workouts. Although student-athletes have superior time management skills, it is very common to feel extremely overwhelmed. Additionally, we constantly deal with the pressures of performance on a daily basis, which can take a toll on the mind.

National surveys show that more than 30 percent of student-athletes have experienced overwhelming anxiety. And 30 percent of college students reported feeling so down at some point during the previous year that it was difficult to function. A lot of student-athletes feel the pressure to be perfect all of the time, and the false perception equating mental toughness to mental health creates a negative stigma and culture where student-athletes are less likely to seek help. Student-athletes also deal with injuries, which can lead to a recovery process that is extremely taxing mentally. While being an athlete is not our sole purpose in life, it is still a huge part of our identity. Injuries can take this away from athletes, being unable to train with your team or compete in the sport you have dedicated so much of your life toward.

One in four college students has a diagnosable mental illness. Student-athletes in particular have reported 2 percent higher rates of stress than non-student-athletes. Mental health is a key component of athletic performance. As student-athletes, it is important to understand that mental toughness and mental health are separate ideals. Seeking resources is an act of strength, not a sign of weakness. With everyone’s help, we can decrease stigma around mental health and bring resources to create a culture of acceptance.

This is the message we strive to send with our #DontBearItAlone campaign. We were inspired by mental health initiatives such as #damworthit and #powe6fulminds launched at schools and Division 1 conferences around the country. Our #DontBearItAlone campaign aims to raise awareness and continue the conversation around mental health support on Cornell’s campus, with an emphasis on the unique struggles and support needed for the athletic community. This fall, we started hosting mental health awareness games through #DontBearItAlone in which athletes wear green attire such as shoelaces or ribbons in support of mental health. These games also have tables to give out mental health information, and educate students and other audience members on where to find support on campus.

SAAC’s mental health effort is in conjunction with all of the work that Cornell Minds Matter (CMM) and other campus organizations have been doing for years. They work closely with administration, faculty, staff, and students to help decrease the stigma surrounding mental health, increase awareness of this important public health problem, and improve existing frameworks surrounding support systems. SAAC focuses on raising awareness within the athletic community in particular, but we work together with other student organizations on campus to make our voice and our efforts stronger. “Spike For Sophie” is co-sponsored by CMM, the Spikeball Club, Athlete Ally (LGBTQ+ inclusion in sports), and the Red Key Athlete Honors Society.

—By Morgan Chall and Jenna Phelps

Morgan Chall ’19, a varsity gymnast, is co-president of Cornell University’s Student-Athlete Advisory Committee (SAAC) and the NCAA Ivy League SAAC Representative. She is a student in Global and Public Health Sciences. 

Jenna Phelps ’20, a volleyball middle blocker, is the SAAC public relations chair. She is a student in applied economics and management.

Follow Cornell SAAC on Twitter: @cornellsaac

Follow Cornell SAAC on Facebook: @bigredSAAC

Follow Cornell SAAC on Instagram: @cornell_saac

Cornell President Promises Holistic Review of Student Mental Health

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Cornell University President Martha E. Pollack says that Cornell will be conducting a “comprehensive review” of student mental health, possibly beginning in early 2019. She says the “team” at Cornell Health had advocated for the review “to provide an opportunity to look holistically at mental health on our campus.”

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Cornell University campus

Pollack’s statement came in a letter dated September 20 to Scott MacLeod and Susan Hack, the co-founders of The Sophie Fund. In a letter dated August 23, they had called on Pollack to “appoint without further delay an independent, external-led task force to review and assess the mental health challenges for Cornell students, and the university’s policies, practices, and programs to address them; and to make recommendations to the Cornell President to ensure that the university is implementing current best practices.”

MacLeod and Hack published their letter to Pollack in a blog post on September 8 headlined, “Time for a Mental Health Task Force at Cornell.”

In her reply to the MacLeod/Hack letter, Pollack said: “We will be conducting a comprehensive review of student mental health at Cornell… The team at Cornell Health—those in both clinical and educational roles—have advocated for this review to provide an opportunity to look holistically at mental health on our campus.”

Pollack said that Cornell Health “will work with the campus community” beginning this semester “to determine the appropriate scope for this review, which could potentially begin in early 2019.”

Pollack thanked MacLeod and Hack “for your advocacy for providing the best possible environment to support the mental health of Cornell students.”

Pollack’s letter did not respond directly to MacLeod/Hack’s request for an “independent, external-led” review. In their letter, they wrote: “The independent task force should be led by a recognized public health expert with a strong background in mental health and without any current or previous ties to Cornell or to organizations and professional associations focused on collegiate mental health.”

In a September 18 email to Cornell students reported by the Cornell Daily Sun, Vice President Ryan Lombardi announced plans for “a comprehensive review of student mental health” that will bring together “internal and external partners.”

In a September 18 email to the Sun, Lombardi said: “While for many years the university has engaged in regular assessment of student mental health needs and evaluation of services and programs, the decision to pursue an additional comprehensive review of student mental health reflects the University’s commitment to promoting health and well-being as a foundation for academic and personal success.”

In a statement to the Graduate and Professional Student Assembly (GPSA) on September 24 reported by the Sun, Lombardi said he “can’t speak … to exactly who” will be conducting the review but that the administration does “envision it being external audiences.”

“I think part of the first step is to understand what we want to look at, and then I think that will really inform that broader question about who’s best to come in,” he said. “Obviously I think we’re going to want people to have expertise in mental health. I don’t want that just to be Cornell folks.”

In her letter to MacLeod and Hack, Pollack noted that the intention to conduct a comprehensive review was cited in an update about “diversity and inclusion” initiatives posted on the Office of the President’s website, apparently in early September, and announced in Lombardi’s email to students on September 18. The reference read as follows:

Conduct a comprehensive review of student mental health.

Cornell Health will work with the campus community during the fall 2018 semester to determine the appropriate scope for a comprehensive review of student mental health at Cornell, anticipating that such a review could potentially begin in early 2019.

MacLeod and Hack, whose daughter Sophie (’14) died by suicide while on a health leave of absence in 2016, initially wrote to Pollack on April 19, 2017 detailing their concerns about “systemic failure” in Cornell’s institutional handling of mental health matters, and calling on her to launch an independent task force review. However, in a letter to MacLeod and Hack on January 11, 2018, Pollack declined their request, citing an “external assessment” conducted by The JED Foundation, JED’s on-site visit to the Cornell campus in the summer of 2017, and Cornell’s “ongoing engagement with the foundation to ensure we are providing holistic support.”

MacLeod and Hack said that they wrote to Pollack in August asking her to reverse her decision after studying the JED review and finding it “plainly insufficient.” They said a glaring omission was the lack of any reference in findings or recommendations regarding the capacity of the Counseling and Psychological Services staff to meet the demands of students for services. Another omission, they said, was the lack of any reference to the capacity of community mental health providers to address the needs of Cornell students referred to those off-campus services by CAPS. They said that the JED-review documents reported no findings and recommendations in areas such as academic workloads and faculty and academic staff handling of students in distress, and appeared to lack a comprehensive assessment of Cornell’s suicide prevention policies and practices.

MacLeod and Hack also questioned the independence of the review, pointing out that institutions of higher education pay The JED Foundation a fee to become what JED calls “partners” in the JED Campus program. They also said that the JED review entailed only one on-site campus visit by a JED External Contributor, one that lasted merely three hours and did not include meetings with any of the community providers who receive many CAPS referrals. They also said it appeared that Cornell had not released all relevant documents pertaining to the JED review.

In response to Pollack’s September 20 letter, MacLeod and Hack said in a statement:

“We welcome President Pollack’s personal engagement and specifically her commitment to conducting a comprehensive review of student mental health at Cornell. We commend Cornell Health for advocating for this review “to provide an opportunity to look holistically at mental health on our campus,” as President Pollack said. Lastly, we are encouraged to know that the Cornell administration will consult with students and other members of the community as the review proceeds.

“There is a mounting mental health crisis facing our young people today, and the goal of the comprehensive review should be not merely to tinker with the existing system but to create a gold standard for supporting student mental health in the years to come. As one of the world’s leading research institutions, Cornell should expect no less of itself.

“We continue to stress the importance of a truly independent, robust, and transparent review, led by an external expert—a recognized public health authority with a strong background in mental health and without any current or previous ties to Cornell. This is vital, both to ensure the best possible outcome and to win the confidence of Cornell students and the wider campus and Ithaca communities that the university administration is doing its utmost to support student mental health.”

The full September 20, 2018 letter from President Pollack:

Dear Ms. Hack and Mr. MacLeod,

Thank you for your letter dated august 23, 2018, and for your care and concern for the mental health and well-being of Cornell students.

As you may have seen in our recently announced diversity and inclusion initiatives (https://president.cornell.edu/diversity-and-inclusion-initiatives/), we will be conducting a comprehensive review of student mental health at Cornell. Beginning this semester, Cornell Health will work with the campus community to determine the appropriate scope for this review, which could potentially begin in early 2019. Vice president Lombardi also shared this news with our students in a message sent on September 18, along with other updates and investments in mental health support services.

The team at Cornell Health—those in both clinical and educational roles—have advocated for this review to provide an opportunity to look holistically at mental health on our campus. We also continue to engage with and support mental health resources in the larger community.

Thank you again for reaching out to me and for your advocacy for providing the best possible environment to support the mental health of Cornell students.

Sincerely,

Martha E. Pollack

Tompkins County Adopts the Zero Suicide Model

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The Tompkins County Legislature on Tuesday unanimously passed a resolution to support the Zero Suicide Model, calling on local healthcare and behavioral healthcare providers to follow the model’s systematic clinical approach to preventing suicides.

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Tompkins County Legislature July 17, 2018

“This is an initiative we can be proud of,” said Shawna Black, chair of the legislature’s Health and Human Services Committee, who sponsored the resolution. “We are going to be one of the first counties in New York State to implement Zero Suicide.”

“We have a lot of work to do as a county to support those that struggle with mental health issues,” Black added. “However, the conversation will continue and our goal of zero suicides will set the standard for our community and it’s providers. As a community we realize the need for honest conversation about suicide prevention and the tools we must implement in order to save lives. I would like to thank the many providers that offer service on a daily basis and for their commitment to the zero suicide initiative.”

The legislative passage of Resolution 7950 came a month after the newly formed Tompkins County Suicide Prevention Coalition voted overwhelmingly to recommend the Zero Suicide Model for healthcare providers as a countywide suicide prevention initiative.

Jay Carruthers, director of the New York State Office of Mental Health’s Suicide Prevention Office, commended the county’s efforts to implement Zero Suicide.

“The suicide prevention work done at the community level in Tompkins County over the last two to three years has been extraordinary,” Carruthers said in a statement to The Sophie Fund. “Creating community partnerships, raising awareness, decreasing stigma, forming a coalition, and most recently working to integrate suicide prevention in health and behavior healthcare services—the Zero Suicide Model—it’s a wonderful accomplishment.

“In fact,” Carruthers added, “a big topic of conversation at Governor Andrew Cuomo’s Suicide Prevention Task Force this year has been how to support robust suicide prevention at the local level. No one approach is going to be enough to materially reduce the number of suicides. It takes community-level public health approaches, a commitment to deliver suicide safer healthcare, and the creation a culture of data-informed programming. The partnership between Tompkins County and the state has been truly exemplary in moving in this direction.”

Sharon MacDougall, Tompkins County deputy commissioner of mental health services, said “the support from our community, the Tompkins County Health and Human Services Committee, and the Legislature is inspiring and incredibly meaningful to our behavioral health providers and clients. Tompkins County Mental Health Services is honored to collaborate with our partners to push forward a vision and commitment for Zero Suicide in our community.”

MacDougall noted that including Tompkins County Mental Health Services, a total of seven local healthcare providers have become “Zero Suicide Champions” by committing to implement the model: Cayuga Medical Center; Alcohol & Drug Council of Tompkins County; Suicide Prevention & Crisis Service; Cornell Health of Cornell University; Family & Children’s Service of Ithaca; and CAP Plan/Preferred.

David Shapiro, president and CEO of Family & Children’s Service, commented: “F&CS has for many years been at the forefront of suicide prevention in Tompkins County through the staff training, team support, and clinical supervision that have become hallmarks of our clinical program. F&CS is one of the founding members of the Tompkins County Suicide Prevention Coalition. Along with committing to the Zero Suicide Model, F&CS is also committed to be a Zero Suicide Champion and will share what we learn with the broader community so that we can all be better prepared to help people who may be at risk to commit suicide. Our commitment to the Zero Suicide Model sets a lofty goal with an aspirational challenge.”

Kent Bullis, executive director of Cornell Health, commented to The Sophie Fund: “Cornell Health supports the Zero Suicide model, and is committed to completing the Zero Suicide Organizational Self-Study this summer and reporting out our experience to the Tompkins County Suicide Prevention Coalition in the spring.”

In March, Cayuga Medical Center became the first major healthcare provider in Tompkins County to endorse the Zero Suicide initiative. “Cayuga Medical Center is committed to Zero Suicide and is currently studying what resources we need to implement,” David Evelyn, vice president for medical affairs, told The Sophie Fund. “We are pursuing the self-assessment.”

In comments to the Legislature prior to Tuesday’s vote, Scott MacLeod of The Sophie Fund said that “adopting the Zero Suicide Model is an important step in addressing the public health problem of suicide and the rising suicide rate.” The Sophie Fund sponsored The Watershed Declaration adopted exactly 15 months earlier in which local healthcare providers pledged to intensify suicide prevention efforts in Tompkins County. The Sophie Fund also co-hosted an expert briefing on the Zero Suicide Model last October at The Statler Hotel on the Cornell campus.

MacLeod thanked the Tompkins County Legislature and the Zero Suicide Champions for their support for the Zero Suicide Model. He also thanked and cited the valuable support provided by Jay Carruthers, director of the state Suicide Prevention Office; Associate Director Sigrid Pechenik; Garra Lloyd-Lester, associate director of the Suicide Prevention Center of New York State; and Michael Hogan, a former New York State mental health commissioner and a developer of the Zero Suicide Model.

The Tompkins County resolution reads in part:

WHEREAS, the Tompkins County Suicide Prevention Coalition endorses the Zero Suicide model as a framework for organizational commitment to safer suicide care in health and behavioral health care systems, and

WHEREAS, suicides are preventable, now therefore be it

RESOLVED, on recommendation of the Health and Human Services Committee, That Tompkins County hereby signs onto the Zero Suicide model to reduce the number of people committing suicides, commit to sharing lessons learned with other counties to support a state-wide initiative and encourage all health and behavioral healthcare to participate in the Zero Suicide model…

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Shawna Black (center), chair of the Health and Human Services Committee

The Zero Suicide Model, sometimes called the “Suicide Safer Care Model,” holds that suicides can be prevented by closing cracks in healthcare systems—that suicide deaths for individuals under care within health and behavioral health systems are preventable.

Specifically, this entails a systematic clinical approach in healthcare systems—training staff, screening for suicide ideation, utilizing evidence-based interventions, mandating continuous quality improvement, treating suicidality as a presenting problem—and not simply relying on the heroic efforts of crisis staff and individual clinicians.

As the Suicide Prevention Resource Center (SPRC) puts it:

“The programmatic approach of Zero Suicide is based on the realization that suicidal individuals often fall through multiple cracks in a fragmented and sometimes distracted healthcare system, and on the premise that a systematic approach to quality improvement is necessary.”

The facts make a compelling case that healthcare settings must play a critical role in preventing suicide. A review of New York State data of 3,564 suicides in 2013–2014 identified that 25 percent of the individuals who took their own lives had been discharged from emergency departments or inpatient facilities within just seven days prior to their suicide deaths.

The data also indicates a strong need to better train clinicians in suicide screening, assessment, intervention, and follow-up. Of 1,585 mental health providers surveyed by the New York State Office of Mental Health in 2014, 64 percent reported little or no specialized training in suicide-specific interventions. Moreover, about 33 percent reported that they did not feel they had sufficient training to assist suicidal patients.

Zero Suicide is at the heart of the 2012 National Strategy for Suicide Prevention, released by the U.S. Surgeon General and the National Action Alliance for Suicide Prevention. The NSSP’s Goal 8 is to “promote suicide prevention as a core component of healthcare services.” Goal 9 is to “promote and implement effective clinical and professional practices for assessing and treating those at risk for suicidal behaviors.”

Zero Suicide is explicitly embraced by the NYS Suicide Prevention Plan 2016–17, entitled 1,700 Too Many. Implementing Zero Suicide in health and behavioral healthcare settings is the first pillar of the suicide prevention strategy outlined in the plan. The second pillar is to “create and strengthen suicide safer communities.”

The Zero Suicide Model builds on breakthroughs such as the Perfect Depression Care Initiative implemented in 2001 by the Henry Ford Health System in Michigan. Its comprehensive approach to mental and behavioral healthcare—incorporating suicide prevention as an explicit goal—demonstrated a 75 percent reduction in the suicide rate among Henry Ford health plan members.

[If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.]